2012-11-14T08:32:06-06:00 2011-12-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2011-01-01 370661234 Saint Anthony's Health Center % MICHAEL L NELSON SAIN 6184652571 One Saint Anthonys Way PO Box 3 Alton IL 620020340 EVERT J KUIPER 6184652571 2012-11-05 true 3142315544 2011 2016-02-24 21:20:13Z EVERT J KUIPER SAINT ANTHONYS WAY PO BOX 340 ALTON IL 62002 88781487 false 0928 X WWW.SAHC.ORG X 1925 IL SPONSORED BY THE SISTERS OF ST. FRANCIS OF THE MARTYR ST. GEORGE, SAINT ANTHONY'S HEALTH CENTER IS A TWO-CAMPUS SYSTEM WITH A MISSION OF MAKING CHRIST'S MERCIFUL LOVE VISIBLE BY PROVIDING QUALITY HEALTH CARE 23 19 928 90 1012918 353881 1488801 99378396 85251852 126632 227117 1550750 1796454 101409659 88764224 23305 26448 0 0 43058216 42110663 0 0 0 53865013 46187995 96946534 88325106 4463125 439118 64767602 59901825 51483075 56018356 13284527 3883469 X SPONSORED BY THE SISTERS OF ST. FRANCIS OF THE MARTYR ST. GEORGE, SAINT ANTHONY'S HEALTH CENTER IS A TWO-CAMPUS SYSTEM WITH A MISSION OF MAKING CHRIST'S MERCIFUL LOVE VISIBLE BY PROVIDING QUALITY HEALTH CARE. false false 39262679 26448 36580394 INPATIENT SERVICES: SAINT ANTHONY'S HEALTH CENTER IS A TWO-CAMPUS, 199-BED ACUTE CARE FACILITY LOCATED IN ALTON, ILLINOIS. COMPRISED OF THE SAINT ANTHONY'S HEALTH CENTER CAMPUS AND SAINT CLARE'S HOSPITAL, THE ORGANIZATION OFFERS THE LATEST IN TECHNOLOGY AND STATE-OF-THE-ART MEDICINE ADMINISTERED WITH COMPASSION AND SKILL. INPATIENT SERVICES BASED AT THE SAINT ANTHONY'S CAMPUS INCLUDE MEDICAL, SURGICAL, AND OBSTETRICS. WE PROVIDE ADDITIONAL SERVICES TO OUR INPATIENTS INCLUDING: PAIN MANAGEMENT, SURGICAL SERVICES, GASTROENTEROLOGY, LABORATORY SERVICES, CARDIOLOGY, STRESS LAB, DIAGNOSTIC RADIOLOGY SERVICES, CARDIOVASCULAR SERVICES, RADIATION THERAPY, ONCOLOGY SERVICES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY. INPATIENT SERVICES AT SAINT CLARE'S HOSPITAL INCLUDE REHABILITATION SERVICES AND A SKILLED NURSING FACILITY. SAINT ANTHONY'S HEALTH CENTER PROVIDES PRIVATE ROOMS TO THEIR INPATIENTS. DURING 2011 SAINT ANTHONY'S HEALTH CENTER HAD 4,043 ADMISSIONS, 23,992 PATIENT DAYS, 414 BIRTHS, AND 672 SURGERIES. 27655375 40140269 OUTPATIENT SERVICES: SAINT ANTHONY'S HEALTH CENTER IS A TWO-CAMPUS, 199-BED ACUTE CARE FACILITY LOCATED IN ALTON, ILLINOIS. COMPRISED OF THE SAINT ANTHONY'S HEALTH CENTER CAMPUS AND SAINT CLARE'S HOSPITAL, THE ORGANIZATION OFFERS THE LATEST IN TECHNOLOGY AND STATE-OF-THE-ART MEDICINE ADMINISTERED WITH COMPASSION AND SKILL. OUTPATIENT SERVICES INCLUDE: CENTER FOR WOUND HEALING & HYPERBARIC MEDICINE, SURGICAL SERVICES, DIABETES SERVICES, HOME-HEALTH SERVICES, CANCER CENTER OF EXCELLENCE, RADIATION ONCOLOGY, CHEMOTHERAPY, ADULT DAY SERVICES PSYCHOLOGICAL SERVICES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, GASTROENTEROLOGY, PAIN MANAGEMENT, CARDIOVASCULAR LAB, DIAGNOSTIC RADIOLOGY, SLEEP STUDIES AND RESPIRATORY CARE SERVICES. DURING 2011 WE PERFORMED 2,403 OUTPATIENT SURGERIES, 131,850 OUTPATIENT REGISTRATIONS, AND 22,725 HOME HEALTH VISITS. 8146360 8531189 EMERGENCY SERVICES: SERVING THE COMMUNITY WITH ADVANCED TECHNOLOGY AND COMPASSIONATE CARE LOCATED ON THE CAMPUS OF SAINT ANTHONY'S HOSPITAL, OUR EMERGENCY DEPARTMENT USES THE LATEST TECHNOLOGY TO EVALUATE MINOR TO MORE SERIOUS, LIFE-THREATENING EMERGENCY NEEDS, WITH 24-HOUR AVAILABILITY OF OPERATING ROOMS, EQUIPMENT, DIAGNOSTIC SERVICES AND STAFFING. SAINT ANTHONY'S EMERGENCY DEPARTMENT USES A MULTI-LEVEL TRIAGE SYSTEM TO PRIORITIZE TRUE EMERGENCIES TO ENSURE IMMEDIATE CARE, FOR ENHANCED PATIENT FLOW, AND SHORTER PATIENT WAIT TIMES. WE OFFER QUALITY PATIENT CARE, BOARD CERTIFIED EMERGENCY ROOM PHYSICIANS, PHYSICIAN'S ASSISTANTS, NURSES, NURSE PRACTITIONERS, AND TECHNICIANS. SAINT ANTHONY'S IS ALSO A DESIGNATED EMERGENCY FACILITY APPROVED FOR PEDIATRICS BY THE STATE OF ILLINOIS PROVIDING SPECIALIZED EMERGENCY CARE FOR CHILDREN - DAY OR NIGHT. DURING 2011 WE HAD 23,534 VISITS TO OUR EMERGENCY ROOM. 75064414 true true false true false false false false true true false false false true false true true false false false false false false false false true true true false true true false true false false false false false false true true false false false false true true false false false false true 111 0 true 928 true true true false false false false false false false false false X 23 19 false false false false true true true true true false false false true true true true true true true true false X MICHAEL L NELSON 6184635616 815 EAST FIFTH STREET SUITE 401 ALTON IL 62002 X DANIEL V BEISER 1.0 X 0 0 0 SISTER M ANSELMA BELONGEA 40.0 X 0 0 0 EDWARD BLAIR JR MD 1.0 X 2288 191659 10823 DALE CHAPMAN 1.0 X 0 0 0 MOTHER M REGINA COURY PACIS 1.0 X 0 0 0 SISTER M KATERI HAWLEY 1.0 X 0 0 0 A JESSE HOPKINS 1.0 X 0 0 0 JAMES HUDSON MD 1.0 X 0 0 0 SALVADOR LOBIANCO MD 1.0 X 6250 0 0 SISTER M MIKELA MEIDL 40.0 X X 0 0 0 THOMAS MOORE 1.0 X 0 0 0 SISTER M STEPHANIE BELGERI 1.0 X 0 0 0 DONALD NORTON 1.0 X 0 0 0 LARRY REED MD 1.0 X 8875 0 0 JANE SAALE 1.0 X 0 0 0 HERMAN SEEDORF 1.0 X 0 0 0 JOAN SHEPPARD 1.0 X 0 0 0 JIM SHRADER 1.0 X 0 0 0 DWIGHT WERTS 1.0 X 0 0 0 STEVEN ZENKER MD 1.0 X 0 0 0 EVERT J KUIPER 40.0 X X 581521 0 65208 SISTER M ANASTASIA MAHER 40.0 X X 0 0 0 SISTER M ALEXANDRA MORRISON 1.0 X 0 0 0 MICHAEL L NELSON 40.0 X 486337 0 199272 MICHAEL RUSSO 40.0 X 182344 0 38026 PATTI FISCHER 13.0 X 133891 0 67501 EUGENE GOTWAY 40.0 X 112176 0 101436 MARY WENDLE 40.0 X 113865 0 109169 DIANE SCHUETTE 40.0 X 110593 0 49538 COREY BATES 40.0 X 110266 0 56184 MARK WEBER X 445482 0 1217 2293888 191659 698374 13 true true false DELL MARKETING LP 120 ROYALL STREET CANTON MA 02021 BILLING SERVICES 1516474 SSM CLINICAL ENGINEERING SERVICE 12312 OLIVE BLVD STE 500 ST LOUIS MO 63141 EQUIPMENT SERVICES 885128 SISTERS OF STFRANCIS OF THE MARTYR 1 FRANSCISCAN WAY ALTON IL 62002 ADMIN&NURSING SRVCS 880542 RIGHTCHOICE 10795 WATSON ROAD SAINT LOUIS MO 63127 HEALTH PLAN ADMIN 727757 ACROPOLIS TECHNOLOGY 915 WHITELAW AVENUE WOOD RIVER IL 62095 IT SERVICES 360685 24 954045 31693 503063 1488801 NET PATIENT REVENUE 621110 85251852 85251852 85251852 84012 84012 0 0 35879 35879 35879 35879 160368 0 0 17263 160368 -17263 143105 143105 0 0 0 CAFETERIA SALES 722210 443572 443572 MANAGEMENT FEE 561000 300000 300000 NON-PATIENT DME SALES 453000 1012918 1012918 4085 4085 1760575 88764224 85251852 1012918 1010653 26448 26448 0 0 0 2016820 2016820 0 0 29152239 26479411 2672828 0 1971280 1790543 180737 6747953 6129266 618687 2222371 1887997 334374 113525 113525 514732 514732 100856 100856 0 0 0 7351499 5165598 2185901 544951 373 544578 16654359 16015956 638403 1187029 267512 919517 0 1662687 1626687 36000 204848 159998 44850 0 26662 494 26168 990790 990790 0 3473602 3283981 189621 1827026 500 1826526 BAD DEBT EXPENSE 8345199 8345199 DPA PROVIDER TAX 2500452 2500452 DUES & SUBSCRIPTIONS 357176 62743 294433 MINOR EQUIPMENT 142824 140688 2136 189778 189778 88325106 75064414 13260692 0 3701 3701 5033017 3888020 0 0 15439564 13099050 0 0 0 0 2960967 3134921 1662136 1579805 2197093 1977835 101784873 74602210 25940395 27182663 10038419 7244527 0 0 1492310 1492275 0 0 0 299028 64767602 59901825 11018054 9924384 0 0 0 0 16421734 13542838 0 0 0 0 1826312 2844028 0 0 22216975 29707106 51483075 56018356 X 11973127 2731504 1311400 1151965 0 0 13284527 3883469 64767602 59901825 X 439118 -9840176 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false true 106 false false true 46270 false 46376 false 2899164 1290200 -9337 0 1444562 0 2735465 2679513 291592 45651 0 117592 0 2899164 2642125 113220 92664 0 168496 0 2679513 2910435 181151 -222283 0 227178 0 2642125 0.55000 0.43000 0.02000 true false 3883217 3883217 48765884 41116020 7649864 37788779 28050317 9738462 11346993 5435873 5911120 27182663 0 THIRD PARTY SETTLEMENTS 3141751 PENSION LIABILITY 24993580 ASSET RETIREMENT OBLIGATION 1571775 29707106 88764224 88325106 439118 -251986 -9588189 -9840175 -9401057 88556184 -251986 1306615 1054629 87501555 127678 1134991 1262669 88764224 88214691 17263 17263 88197428 127678 127678 88325106 INTENDED USES OF ENDOWMENT FUNDS PART V, LINE 4 THESE FUNDS ARE TO BE USED FOR FUTURE CAPITAL IMPROVEMENTS, FUTURE RETIREMENT PLAN CONTRIBUTIONS AND OTHER USES OVER WHICH THE BOARD RETAINS CONTROL AND MAY AT ITS DISCRETION SUBSEQUENTLY USE FOR OTHER PURPOSES. ON PRIOR RETURNS THERE WERE AMOUNTS INCLUDED IN ENDOWMENT FUNDS IN ERROR. THE THREE PREVIOUS YEARS LISTED ON THIS RETURN HAVE BEEN CORRECTED TO ONLY INCLUDE ENDOWMENT FUNDS. FIN 48 PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. OTHER CHANGES IN NET ASSETS PART XI, LINE 8 CHANGE IN VALUE OF TEMPORARILY RESTRICTED NET ASSETS ($5,074) FAS 158 ADJUSTMENT ($6,531,080) CHANGE IN INVESTMENT IN UNCONSOLIDATED ORGANIZATIONS ($35) TRANSFER TO ST. ANTHONY HEALTH SYSTEM ($3,052,000) TOTAL ($9,588,189) OTHER REVENUE ON BOOKS BUT NOT ON RETURN PART XII, LINE 2D LOSS FROM SALE OF ASSETS $17,263 RELEASE FROM RESTRICTIONS $1,289,352 TOTAL $1,306,615 OTHER REVENUE ON RETURN BUT NOT ON F/S PART XII, LINE 4B RESTRICTED CONTRIBUTION REVENUE $1,134,991 OTHER EXPENSES ON BOOKS BUT NOT ON RETURN PART XIII, LINE 2D LOSS FROM SALE OF ASSETS $17,263 true true X true X true X 600. true true true false true false 3348000 3348000 0.04190 12107409 10532572 1574837 0.01970 15455409 10532572 4922837 0.06160 208 708779 27104 681675 0.00850 1231 1138877 1138877 0.01420 20894 323391 280123 43268 0.00050 70575 70575 0.00090 22333 2241622 307227 1934395 0.02410 22333 17697031 10839799 6857232 0.08570 true 1530000 76500 32231163 31080438 1150725 X true true 2 1 SAINT ANTHONY'S HOSPITAL

ONE SAINT ANTHONYS WAY ALTON IL 62002

X X X 2 SAINT CLARE'S HOSPITAL

915 EAST FIFTH STREET ALTON IL 62002

X ACUTE INPATIENT PHYSICAL REHABILITATION SAINT ANTHONY'S HOSPITAL 1 true true 200. true 600. true X X X X X X true true X X X X true false X true X false false SAINT CLARE'S HOSPITAL 2 true true 200. true 600. true X X X X X X true true X X X X true false X true X false false 1 Saint Anthony's Imaging Center

325 East Madison Avenue Wood River IL 62095

Outpatient diagnostic radiology facility COSTING METHODOLOGY PART I, LINE 7 THE ORGANIZATION USES THE COST TO CHARGE RATIO FROM WORKSHEET C OF THEIR MEDICARE COST REPORT AS THEIR COSTING METHODOLOGY FOR THE AMOUNTS IN THE TABLE ON PART I, LINE 7. PART I, LINE 7, COLUMN F: THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $8,345,199 REPORTED ON PART IX, LINE 24 OF THE FORM 990; HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS PART I, LINE 7, COLUMN F. BAD DEBT EXPENSE PART III, LINE 4A THE HEALTH CENTER'S TOTAL COST OF UNCOMPENSATED CARE RELATING TO CHARITY CARE AND UNCOLLECTIBLE ACCOUNTS ARE AS FOLLOWS FOR 2011: CHARITY CARE - $3,348,000, UNCOLLECTIBLE ACCOUNTS - $1,530,000, AND TOTAL COSTS OF UNCOMPENSATED CARE - $4,878,000. IN ADDITION TO THESE COSTS OF UNCOMPENSATED CARE, THE HEALTH CENTER ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF SUPPORTING OR FINANCIALLY VIABLE. BAD DEBT METHODOLOGY PART III, LINE 4B THE AMOUNT ON LINE 2 WAS DETERMINED USING THE COST TO CHARGE RATIO FROM WORKSHEET C OF THE MEDICARE COST REPORT AS APPLIED TO THE TOTAL BAD DEBT EXPENSE TO CALCULATE THE COST OF UNCOLLECTIBLE ACCOUNTS. WE DO NOT INCLUDE ANY BAD DEBT IN OUR COMMUNITY BENEFIT. MEDICARE PART III, LINE 8 THE COST ON LINE 6 IS FROM THE FILED 12/31/2011 MEDICARE COST REPORT. WE DO NOT INCLUDE THE COST OF MEDICARE IN OUR COMMUNITY BENEFIT REPORT. COLLECTION PRACTICES PART III, LINE 9B IF THERE IS A BALANCE LEFT AFTER CHARITY CARE HAS BEEN APPLIED OR FINANCIAL ASSISTANCE APPROVED, THEN PAYMENT ARRANGEMENTS ARE MUTUALLY AGREED UPON BY BOTH THE APPLICANT AND SAINT ANTHONY'S HEALTH CENTER. BILLING AND COLLECTIONS PART V, SECTION B, LINE 17 SAINT ANTHONY'S HEALTH CENTER DOES NOT PERFORM ANY OF THE ACTIONS IN QUESTION 16 PRIOR TO DETERMINING ELIGIBILITY UNDER OUR FINANCIAL ASSISTANCE POLICY. THERE ARE SIGNS POSTED IN OUR REGISTRATION OFFICES AS WELL AS OUR EMERGENCY ROOMS ADVISING PATIENTS THAT THERE IS FINANCIAL ASSISTANCE AVAILABLE. THE POLICY AND APPLICATION ARE AVAILABLE ON OUR WEBSITE. WE ALSO NOTIFY PATIENTS THAT THERE IS A FINANCIAL ASSISTANCE POLICY AVAILABLE WHEN DISCUSSING THEIR PATIENT BILL. PATIENTS ARE NOTIFIED VIA MAIL UPON ACCEPTANCE OR DENIAL OF FINANCIAL ASSISTANCE. CHARGES FOR MEDICAL CARE PART V, SECTION B, LINE 19 WE BILL EVERYONE A STANDARD CHARGE PER CMS REQUIREMENTS. ALL UNINSURED RECEIVE AT LEAST A 25% DISCOUNT OFF CHARGES. THOSE AT OR BELOW 600% OF FPG RECEIVE A WRITE OFF DISCOUNT OF 75% TO 100%. SAINT ANTHONY'S HEALTH CENTER IS IN COMPLIANCE WITH THE STATE OF ILLINOIS LAW THAT INDIGENT AND UNINSURED WILL NOT BE EXPECTED TO PAY MORE THAN 135% OF COST. NEEDS ASSESSMENT PART VI, LINE 2 SAINT ANTHONY'S HEALTH CENTER MAINTAINS ONGOING DIALOGUE WITH KEY MEMBERS OF THE COMMUNITY SUCH AS HEADS OF VARIOUS COMMUNITY ORGANIZATIONS, CHARITY ORGANIZATIONS, AND EDUCATIONAL INSTITUTIONS. THE DIALOGUE AND RELATIONSHIPS WITH THESE COMMUNITY MEMBERS ASSISTS US IN UNDERSTANDING THE HEALTH NEEDS OF THE COMMUNITY, AND HOW WE CAN BEST POSITION OURSELVES TO SUPPORT THE NEEDS OF THE COMMUNITY. WE HAVE, PERIODICALLY, COMPLETED FOCUS GROUPS WITH MEMBERS OF THE COMMUNITY TO ASCERTAIN THEIR VISION OF WHAT IS NEEDED FROM A HEALTH CARE PERSPECTIVE. WE ALSO SEEK TO UNDERSTAND THE DEMOGRAPHICS OF OUR SERVICE AREA, AS THAT OFTEN HELPS US ZERO IN ON THE PARTICULAR HEALTH NEEDS OF THE COMMUNITY. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 DOCUMENTATION IS PROVIDED AT THE TIME OF REGISTRATION INFORMING PATIENTS THAT THERE IS FINANCIAL ASSISTANCE AVAILABLE. THE DOCUMENTATION PROVIDES THE NAMES AND PHONE NUMBERS OF OUR FINANCIAL COUNSELORS. WHEN NOTIFIED BY A PATIENT, OUR FINANCIAL COUNSELORS WORK INDIVIDUALLY WITH EACH APPLICANT SCREENING THEM FOR THEIR ELIGIBILITY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. COMMUNITY INFORMATION PART VI, LINE 4 THE CITY OF ALTON, IL LOCATED 15 MILES NORTH OF ST. LOUIS, MO, PLUS THE SURROUNDING CITIES AND TOWNSHIPS OF GODFREY, EAST ALTON, WOOD RIVER, BETHALTO, JERSEYVILLE, BRIGHTON, AND COTTAGE HILLS COMPRISE OUR PRIMARY SERVICE AREA (PSA). PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 SAINT ANTHONY'S HEALTH CENTER MAINTAINS AN OPEN MEDICAL STAFF. WE INCLUDE NUMEROUS COMMUNITY MEMBERS ON OUR GOVERNING BOARD AND SAINT ANTHONY'S FOUNDATION BOARD. THE HOSPITAL OPERATES AT LOW PROFIT MARGINS AND AT LOW CASH LEVELS, RETURNING SURPLUSES TO ENHANCE THE MISSION OF THE FACILITY. AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 SAINT ANTHONY'S HEALTH SYSTEM CONSISTS OF SAINT ANTHONY'S HEALTH CENTER AND SAINT ANTHONY'S PHYSICIAN GROUP. SAINT ANTHONY'S PHYSICIAN GROUP IS INSTRUMENTAL IN FULFILLING THE HEALTH NEEDS OF THE COMMUNITY THROUGH ITS PHYSICIAN PROVIDERS. TO MEET THE NEEDS OF OUR COMMUNITIES, SAINT ANTHONY'S PHYSICIAN GROUP HAS ADDED 10 PHYSICIANS DURING 2011 PROVIDING SERVICES FOR UROLOGY, GASTROENTEROLOGY, EAR-NOSE-THROAT, PRIMARY CARE PHYSICIANS, AND A SURGEON. WHERE SAINT ANTHONY'S PHYSICIAN GROUP OFFERS THE PHYSICIAN SERVICES TO OUR POPULATION, THE HEALTH CENTER PROVIDES THE FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES TO FULFILL THE NEEDS IDENTIFIED BY THE PHYSICIANS. DIALOGUE WITH OUR MEDICAL STAFF IS AN IMPORTANT MEANS OF UNDERSTANDING THE NEEDS OF OUR POPULATION, AS WELL. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IL, true X PROCEDURES FOR MONITORING GRANT FUNDS PART I, LINE 2 TRADITIONALLY, SAINT ANTHONY'S HEALTH CENTER DOES NOT OFFER GRANTS OR ASSISTANCE. ALL DONATIONS WERE MADE TO PRE-SELECTED, REPUTABLE, PUBLICLY SUPPORTED CHARITABLE ORGANIZATIONS. X X true true X X X X false true false false false false false true false EDWARD BLAIR JR MD 2288 190658 0 0 0 1001 0 0 0 10823 2288 202482 0 0 MARK WEBER 425000 0 0 0 20482 0 0 0 1217 0 446699 0 0 0 EVERT J KUIPER 373500 0 178840 0 29181 0 39469 0 25739 0 646729 0 0 0 MICHAEL L NELSON 225469 0 0 0 260868 0 183864 0 15408 0 685609 0 182931 0 MICHAEL RUSSO 76636 0 32032 0 73676 0 27484 0 10542 0 220370 0 0 0 PATTI FISCHER 132860 0 0 0 1031 0 62129 0 5372 0 201392 0 0 0 EUGENE GOTWAY 111694 0 0 0 482 0 81114 0 20322 0 213612 0 0 0 MARY WENDLE 112857 0 0 0 1008 0 88473 0 20696 0 223034 0 0 0 DIANE SCHUETTE 110035 0 0 0 558 0 47184 0 2354 0 160131 0 0 0 COREY BATES 109962 0 0 0 304 0 45993 0 10191 0 166450 0 0 0 DESCRIPTION OF ADDITIONAL BENEFITS PROVIDED PART I, LINE 1A COUNTRY CLUB BENEFITS WERE PROVIDED TO THE FOLLOWING OFFICERS: EVERT KUIPER $8,144 MICHAEL NELSON $8,079 ALL OF THESE AMOUNTS WERE INCLUDED IN THEIR TAXABLE COMPENSATION. EVERT KUIPER ALSO RECEIVED TAX GROSS-UP PAYMENTS IN THE AMOUNT OF $10,947, WHICH WERE INCLUDED IN TAXABLE COMPENSATION. TAX GROSS-UPS IN THE AMOUNT OF $3 WERE APPLIED TO ALL OTHER EMPLOYEES FOR GIFT CARDS GIVEN OUT AT CHRISTMAS. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS PART I, LINE 4B MICHAEL NELSON $251,704 MICHAEL RUSSO $72,567 THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS WERE MADE IN ACCORDANCE WITH EACH INDIVIDUAL'S EMPLOYMENT CONTRACT AND WERE INCLUDED IN THEIR TAXABLE COMPENSATION. NONQUALIFIED RETIREMENT PLANS INCLUDE ACTURIAL VALUES THAT FLUCTUATE WITH MARKET CONDITIONS. NON-FIXED PAYMENTS PART I, LINE 7 EVERT KUIPER EARNED BONUSES TOTALING $78,840 BASED ON FINANCIAL OUTCOMES, PATIENT SATISFACTION SCORES, BOARD EVALUATIONS, AND EPOB (EMPLOYEE PER OCCUPIED BED) TARGETS BEING MET. ILLINOIS FINANCE AUTHORITY 861091967 2004-11-30 4975000 Construction & Equipment Purchase false false false ILLINOIS FINANCE AUTHORITY 861091967 2010-03-18 10000000 Construction & Equipment Purchase false false false 0 0 4975000 0 0 0 0 0 0 4975000 0 0 2007 false false true true 0 0 10000992 0 0 0 101424 0 0 7927608 0 1971960 2012 false false false true false false false false 0 true false false false false 0 true false false false 0 false 0 false false false false false 0 false 0 false false TOTAL PROCEEDS OF ISSUE PART II, LINE 3 PART II, LINE 3, COLUMN B, INCLUDES $992 OF INTEREST EARNINGS IN THE ESCROW ACCOUNT. TERESA BEISER SPOUSE IS DIRECTOR 64171 EMPLOYEE COMPENSATION false INTENSIVO LLC OWNED BY DR. LOBIANCO, 208800 CRITICAL CARE PROVIDER false INTENSIVO LLC DIRECTOR DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS PART VI, LINE 6 SAINT ANTHONY'S HEALTH CENTER HAS ONE MEMBER, DESIGNATED AS THE CORPORATE MEMBER, WHICH SHALL BE SAINT ANTHONY'S HEALTH SYSTEM, AN ILLINOIS NOT-FOR-PROFIT CORPORATION. SAINT ANTHONY'S HEALTH SYSTEM SHALL ACT IN STEWARDSHIP CAPACITY AND ENSURE THAT ALL ACTIONS OF SAINT ANTHONY'S HEALTH CENTER ARE CONSISTENT WITH THE PURPOSES, AND ETHICAL AND RELIGIOUS PRINCIPLES IN FURTHERANCE OF THEIR CHARITABLE APOSTOLATE OF QUALITY HEALTH CARE. DESCRIPTION APPROVAL AND VOTING RIGHTS OF MEMBERS OR STOCKHOLDERS PART VI, LINE 7A AND 7B SAINT ANTHONY'S HEALTH SYSTEM HAS THE EXCLUSIVE POWER TO APPOINT AND REMOVE THE DIRECTORS AND THE PRESIDENT/CEO, ADOPT, AMEND, RESTATE AND REPEAL THE ARTICLES OF INCORPORATION AND THE BYLAWS, ADOPT ANY PLAN OF MERGER, CONSOLIDATION, OR DISSOLUTION, ADOPT STATEMENT OF PHILOSOPHY, MISSION, AND APOSTALATE, ESTABLISH A CORPORATE LIMIT FOR EXPENDITURES, AND APPROVE THE MISSION STATEMENT, STRATEGIC PLAN, AND ANNUAL OPERATING BUDGET. SAINT ANTHONY'S HEALTH SYSTEM MUST APPROVE PURCHASES, SALES, TRANSFERS, LEASES OR ENCUMBRANCES OF REAL PROPERTY OR OF SUBSTANTIALLY ALL OF THE PERSONAL PROPERTY, BORROWING WHICH IS IN EXCESS OF THE CORPORATE LIMIT AS DETERMINED FROM TIME TO TIME BY SAINT ANTHONY'S HEALTH SYSTEM, THE EXECUTION OF ANY DEEDS, MORTGAGES, OR BONDS, ANY TRANSACTION WHICH INVOLVES AN ALIENATION OF PROPERTY OR OTHER ACT OF EXTRAORDINARY ADMINISTRATION, AND EXTRAORDINARY MEDICAL/MORAL ISSUES AND ANY MATTER CHALLENGING THE CATHOLICITY OF SAINT ANTHONY'S HEALTH CENTER. PROCESS TO REVIEW 990 PART VI, LINE 11 SAINT ANTHONY'S HEALTH CENTER USES AN OUTSIDE PREPARER TO PREPARE ITS FORM 990 AND 990-T. ONCE COMPLETED, THE RETURNS ARE REVIEWED INTERNALLY BY THE PRESIDENT/CEO, EVP/CFO AND THE VP/CONTROLLER BEFORE FILING. ANNUALLY, THE RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, FORM 990, AND THE EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN, FORM 990-T, WILL BE PROVIDED TO THE SAINT ANTHONY'S HEALTH SYSTEM GOVERNING BOARD AND SAINT ANTHONY'S HEALTH SYSTEM FINANCE COMMITTEE FOR REVIEW PRIOR TO FILING SUCH RETURNS WITH THE INTERNAL REVENUE SERVICE FOR SAINT ANTHONY'S HEALTH CENTER, SAINT ANTHONY'S PHYSICIAN GROUP, AND SAINT ANTHONY'S FOUNDATION. WRITTEN NOTIFICATION WILL BE SENT TO EACH OF THE GOVERNING BOARDS' MEMBERS OF SAINT ANTHONY'S HEALTH CENTER, SAINT ANTHONY'S PHYSICIAN GROUP, AND SAINT ANTHONY'S FOUNDATION ADVISING THEM THAT THE RETURNS HAVE BEEN FILED AND TO CONTACT MICHAEL NELSON AT (618) 463-5616 IF THEY WOULD LIKE TO REVIEW THEIR RESPECTIVE RETURN. COMPLIANCE WITH CONFLICT OF INTEREST POLICY PART VI, LINE 12C A CONFLICT OF INTEREST DISCLOSURE STATEMENT MUST BE COMPLETED ANNUALLY BY: ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, DIRECTORS, MANAGERS, EMPLOYED PHYSICIANS, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICAL AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST; AND NON-EMPLOYED MEMBERS OF THE MEDICAL STAFF WHO ALSO EITHER: HOLDS PAID OR UNPAID MEDICAL ADMINISTRATIVE POSITIONS OR HAVE PROCUREMENT RESPONSIBILITY OR THE AUTHORITY EFFECTIVELY TO RECOMMEND SUCH PROCUREMENT. THE STATEMENTS ARE REVIEWED ANNUALLY BY THE PRESIDENT/CEO AND THE BOARD SECRETARY. ANY MEMBER OF A BOARD INCLUDING PHYSICIANS SHALL REFRAIN FROM VOTING ON ANY POTENTIAL CONFLICTS. PROCESS FOR DETERMINING COMPENSATION PART VI, LINE 15A IN 2010, HEWITT ASSOCIATES WAS ENGAGED TO PERFORM A REVIEW OF EXECUTIVE COMPENSATION, INCLUDING ALL DISQUALIFIED PERSONS. HEWITT ASSOCIATES ISSUED AN OPINION LETTER SHOWING REBUTTABLE PRESUMPTION OF REASONABLENESS OF EXECUTIVE COMPENSATION FOR SAINT ANTHONY'S. THIS ANALYSIS INVOLVED COMPARABLE DATA. SAINT ANTHONY'S CONTINUES TO USE HEWITT SERVICES AND COMPARABLE DATA WHEN MAKING ANY CHANGES TO EXECUTIVE COMPENSATION. THE COMPENSATION COMMITTEE OF THE HEALTH SYSTEM BOARD OVERSEES MATTERS OF EXECUTIVE COMPENSATION AND UTILIZES OUTSIDE CONSULTING SERVICES WHEN APPROPRIATE. THE PROCESS IS DOCUMENTED IN COMPENSATION COMMITTEE MEETING MINUTES. THERE HAVE BEEN NO CHANGES TO THIS PROCESS IN THE PAST YEAR. LINE 15B: THE COMPENSATION COMMITTEE OF SAINT ANTHONY'S HEALTH SYSTEM, PARENT CORPORATION, RELIED ON MARKET SURVEYS AND COMPENSATION ANALYSIS COMPLETED BY HEWITT ASSOCIATES DURING 2010 TO REVIEW AND APPROVE SALARIES FOR SENIOR TEAM MEMBERS IN THE SPRING OF 2011. ALL OF THIS ACTIVITY IS DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE. AVAILABILITY TO THE PUBLIC PART VI, LINE 19 FINANCIAL INFORMATION IS PROVIDED IN ACCORDANCE WITH THE FREEDOM OF INFORMATION ACT. OTHER CHANGES TO NET ASSETS PART XI, LINE 5 NET UNREALIZED GAINS ($251,987) CHANGE IN TEMPORARILY ($5,074) RESTRICTED ASSETS FAS 158 ADJUSTMENT ($6,531,080) CHANGE IN INVESTMENT IN ($35) UNCONS. ORGANIZATIONS TRANSFER TO ST. ANTHONY'S ($3,052,000) HEALTH SYSTEM ____________ TOTAL CHANGE IN NET ASSETS ($9,840,176) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER M. ANSELMA BELONGEA TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EDWARD BLAIR, JR., MD. TITLE:DIRECTOR HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MOTHER M. REGINA COURY PACIS TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER M. KATERI HAWLEY TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:A. JESSE HOPKINS TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER M. MIKELA MEIDL TITLE:CHAIR - DIRECTOR HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONALD NORTON TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DWIGHT WERTS TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EVERT J KUIPER TITLE:PRESIDENT/CEO HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER M. ANASTASIA MAHER TITLE:SECRETARY HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL L NELSON TITLE:EVP/CFO HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PATTI FISCHER TITLE:VP OF PHYSICIAN SERVICES HOURS:27 SAINT ANTHONY'S LLC 915 EAST FIFTH STREET ALTON IL 62002 371407745 ASSISTED LIV. 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